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Visceral Pain Procedures

Abdominal and pelvic pain is mediated by nerves that coalesce with specific ganglia near the lumbar spine. The well-defined location of these ganglia allow for interventions designed to alleviate chronic abdominal or pelvic pain.

Abdominal pain may be treated with a celiac plexus axis intervention. The celiac plexus is located just anterior to the aorta at the L1 vertebral level. For malignant pain such as pancreatic, stomach or liver cancer, this intervention may consist of the precise injection of alcohol which destroys the nerves that mediate pain. This is a precise injection that requires X-ray localization and intense post-procedure monitoring and treatment of side-effects. Prior to the neurolytic block, a diagnostic block with local anesthetic is usually performed in order to demonstrate efficacy of the technique and lack of serious complications. For benign pain conditions that demonstrate short-term improvement with local anesthetic celiac plexus block, radiofrequency neuroablation of the bilateral greater and lesser splanchnic nerves may be performed. This splanchnic nerve procedure may be repeated indefinitely, typically at six to twenty-four month intervals.

Pelvic pain is mediated through the superior hypgastric plexus which is located anterior the spine at the L5-S1 vertebral level. Again, this injection requires X-ray guidance at an ambulatory surgery center as well as a diagnostic block with local anesthetic prior to using alcohol for neuroablation. Because this procedure may have negative side-effects involving bowel and bladder function, the neurolytic procedure is usually limited to malignancies involving the pelvic organs.

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